Department of Hematology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands.
AIMM Therapeutics, Amsterdam, The Netherlands.
Eur J Haematol. 2019 Nov;103(5):491-499. doi: 10.1111/ejh.13315. Epub 2019 Aug 14.
Relapse of AML after allogeneic hematopoietic stem cell transplantation (HSCT) has a poor prognosis, and standard of care therapy is lacking. Early (<6 months) relapse is associated with dismal outcome, while the majority of relapses occur early after transplantation. A more precise indication which patients could benefit from reinduction therapy is warranted.
We retrospectively analyzed outcomes of 83 patients with postallogeneic HSCT relapse. Patients were divided based on intention to treat (curative vs supportive care).
Of the 50 patients treated with curative intent, 44% reached complete remission (CR) upon reinduction chemotherapy, and of these patients, 50% survived. Two survivors reached CR after immunotherapy (donor lymphocyte infusion (DLI), without reinduction chemotherapy). Sixty-nine percent of the survivors had received high-intensity cytarabine treatment, followed by immunologic consolidation. Relapse <3 months after transplantation was predictive for adverse survival (P = .004), but relapse <6 months was not. In fact, >50% of the survivors had a relapse <6 months.
We confirmed the dismal prognosis of postallogeneic HSCT relapse. Importantly, our data demonstrate that patients fit enough to receive high-dose chemotherapy, even when relapse occurred <6 months, had the best chance to obtain durable remissions, in particular when immunologic consolidation was performed after reaching CR.
异基因造血干细胞移植（HSCT）后 AML 复发预后不良，且缺乏标准治疗方法。早期（<6 个月）复发与预后不良相关，而大多数复发发生在移植后早期。需要更精确的指标来确定哪些患者可以从再诱导治疗中获益。
我们回顾性分析了 83 例异基因 HSCT 后复发患者的结局。根据治疗意图（治愈性 vs 支持性治疗）将患者进行分组。
在 50 例接受治愈性治疗的患者中，44%在再诱导化疗后达到完全缓解（CR），其中 50%的患者存活。2 例幸存者在接受免疫治疗（供者淋巴细胞输注（DLI），未进行再诱导化疗）后达到 CR。69%的幸存者接受了高强度阿糖胞苷治疗，随后进行免疫巩固。移植后<3 个月的复发与不良生存相关（P =.004），但<6 个月的复发与生存无关。事实上，超过 50%的幸存者在<6 个月内复发。
我们证实了异基因 HSCT 后复发的预后不良。重要的是，我们的数据表明，即使在<6 个月时复发，能够接受大剂量化疗的患者，尤其是在达到 CR 后进行免疫巩固时，获得持久缓解的机会最大。
